A Rinty For Kids Foundation, incorporated ~ ARFkids

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Application for a
Pet Assisted Therapy Dog Candidate Puppy

* required
Name of Recipient:*
Date of Birth:
Age:*
Gender:
Disability:
Name and ages of Siblings:*
Name of Parent or Guardian:*
Street Address:*
City:*
State:*
Zip Code:*
Daytime Phone Number:*
Evening Phone Number:*
Email:*
Other Contact Number:
Place of Employment:*
Street Address:
City:*
State:*
Zip Code:
Type of Work:*
Are you applying for a Pet Assisted Therapy Dog?:*
  yes    no
Is the ARFkids dog Recipient in school?:
  yes    no
If yes, what school?:
Street Address:
City:
State:
Zip Code:
Grade:
Number of Children in Class:
If not in school, does the recipient work?:
  yes    no
Describe a typical day for the recipient including all routine activities:
 
What are the recipient's goals for the future?:
Do you live in a: House
Apartment
With a family member?
Other:
If the receipient will live with others, will they object to the ArfKids dog being in the house?:
  yes    no
Do you have other animals: yes    no
If so, what kind?:
If you have a dog, what breed?:
Age?:
Dog's sex: female    male
Is the dog altered: yes    no
Do you allow your dog to run loose?: yes    no
Is your dog allowed indoors?: yes    no
Do you have a veterinarian who cares for your animals?:
  yes    no
Veterinarian's Name:
Street Address:
City:
State:
Zip Code:
Do you have a fenced yard?: yes    no
What will be expected of the ARFkids Dog who will assist the recipient?:
 
What tasks will you expect the ArfKids Dog to perform for the recipient?:
 
Will the recipient be willing to work with any breed of dog that ArfKids determines will be most suitable for the situation?:
  yes    no
If no, explain:
Will the recipient be willing to take responsibility for the care of the ArfKids Dog:
  yes    no
If no, who will care for the dog?:
Will the recipient be willing and able to clean up after the dog:
  yes    no
Will the recipient be willing and able to brush the dog:
  yes    no
Will another person be responsible for grooming?:
  yes    no
If yes, please explain:
    











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